Mostrando entradas con la etiqueta HIV test. Mostrar todas las entradas
Mostrando entradas con la etiqueta HIV test. Mostrar todas las entradas

lunes, 24 de octubre de 2016

We save one woman, we save one community (II)


Prevention of maternal death from an integrative perspective.




InPublic Health field,  health communitarian agent has ccontributed to decreasing maternal and child deaths because of the influence over people to change attitude and behavior, form sanitary brigades, contribute to recruiting, identification, and following of risk groups, pregnants are better informed about benefits of a well-controlled pregnancy, also transfer of pregnant and risk population to increasing of vaccination coverage in rural and urban/marginal zones, etc.

That’s why this 3-month project takes advantage of communitarian agents in the territory we are intervening on - the people inside a community with leadership skills, I mean.
This agent joins a team formed by:
  • Who coordinates sexual and reproductive (SRH) strategy in the larger territory in terms of decision power.
  • Representative of the territory’s municipality where we are intervening on.
  • Delegate of a repressentative grassroot organization in the territory we are intervening on.
  • Who lead the health stands inside our territory.
  • SRH responsibles in health stands inside the territory .
This intervention looks for improving the attention by activities of health promotion through multi-sector participation and civile society commitment.
Specifically, it is focused on
1) Getting to recruit communitarian agents (CA) assuring one-per-town in the territory we are intervening at least.
2) Guaranteeing the permanent and integral training of CA.
3) Promoting the active and coordinated role of CA for the promotion of sexual and reproductive health services, identiffication of alarm signs, and users’ communitarian referral.
4) Granting non-bill bonuses for CA, enhancing their participation in the communitarian work.
5) Granting the right certification to the CA’s job.

This proposal is outlined by the multi-sector participative action. In that sense,  the reaching of the goal will be consequence of gotten sinergies among the different sectors.
It is necessary to say that Peru’s Ministry of Health has been developing successful experiences of health promotion by communitarian participation. One of those experiences has been the work with health communitarian agents, what has shown great efectiveness to face the sector’s problems.

Those agents demonstrated his commitment making actions of health prevention and promotion in their community. On this work, health stands and non-profit organizations had a singular importance, which  have contributed to improve the health communitarian agent’s skills for facing emergencies and communitarian health issues.

Post-produced by Sheyla Benavente.



martes, 18 de octubre de 2016

Salvamos una mujer, salvamos una comunidad (I)


Interviniendo para reducir muertes maternas

Por: Marco Paulini Espinoza



La salud es un derecho humano fundamental que debe promoverse desde una perspectiva preventiva; además, la mortalidad materna constituye el indicador sanitario que con total fidelidad evidencia el grado de organización y accesibilidad de los servicios de salud.

Uno de los objetivos del sistema de salud es la mejora de sus servicios, logrando el mejor nivel de calidad (el sistema debe ser bueno), así como deben disminuir las diferencias entre las personas y los grupos (el sistema debe ser equitativo); entonces, hablamos de calidad de atención si el sistema responde de acuerdo a lo que las personas esperan de él, y es equitativo siempre que el sistema responda sin discriminación entre las personas.
Con base en la iniciativa tomada por la Dirección Subrregional de Salud Luciano Castillo Colonna en 2015 (primera medición del Plan de Mejoras del Desempeño), que demostró un nivel de calidad intermedio en los procesos de atención de salud, mediante la implementación de esta iniciativa se busca garantizar el derecho a la salud en términos de calidad.

La intervención dura tres meses y se concentra en los procesos de atención en Salud Sexual y Reproductiva (SSR) que se brindan en los establecimientos de salud.
En el aspecto global, la intervención se enfoca en mejorar la atención en salud mediante actividades dirigidas al fortalecimiento continuo de los procesos a través de la aplicación de técnicas y herramientas para la gestión de la calidad; con la participación multisectorial y el compromiso de la sociedad civil.

Puntualmente pretende garantizar la capacidad de respuesta del sector salud para la reducción de la mortalidad materna y perinatal, y asegurar la participación de la familia y la comunidad y otros actores de la sociedad civil en el sistema de salud para la reducción de la mortalidad materna y perinatal.

El enfoque metodológico que se da en esta propuesta está enmarcado en la investigación (medición) y acción participativa; en ese sentido el logro del objetivo será consecuencia del análisis de los resultados obtenidos.
El equipo que manejará la intervención (equipo de mejora) está compuesto por:
  • La persona que coordina la estrategia de SSR en la jurisdicción con mayor poder de decisión,
  • Las personas encargadas de cada establecimiento de salud dentro de la jurisdicción a intervenir,
  • Los responsables de la estrategia de SSR en cada establecimiento de salud dentro de la jurisdicción a intervenir, y
  • un responsable de intervención (que la monitorea a todo nivel).
LA idea está basada en experiencias exitosas llevadas a cabo durante los últimos 20 años en San Martín, Ucayali, Ayacucho, Madre de Dios, Loreto, Cusco,  Lima y Apurímac.

Post-producido por Sheyla Benavente.

viernes, 14 de octubre de 2016

Teenage Pregnancy – whose mistake?




We must start from the premise what speaking about teenage pregnancy is speaking about a risky pregnancy – it does not only imply a risk for the mother but also for her child, with a big probability of morbility-mortality for both during pregnancy, birth and/or puerperium.

We must have in mind teenage pregnancy is not only a problem of female teenager but it covers to male teenager, families of both an society itself, closing so a group of sequels repercuting on health and development of involved individuals inside this issue.

Once this anchors person to individual under-development in most cases, it has a big impact in social-economic development of population, limiting its resources.
In this point, the teenager must be considered as a changemaker for social development, investing to give him or her tools for his or her skills development; assuming, respecting and spreading their rights as persons, and creating spaces for their development as social members as well.

All this need becomes visible when reviewing the greater amounts of teenage pregnancy because of lack of information on sexual and reproductive health(SRH), which means the teenager does not know rights, rights to perform sexuality based on self-rating as a free, informed and totally regarding responsible person, and the need of sexual education that allows developing skills to postergate the beginning age of sexual relations, if they decide it so.

Why must not a teenager get pregnant?
It is known, in most cases, that teenage pregnancy is not free, informed and much less planned, having an impact on personal and social area, not taking health issues yet, limiting development opportunities, as well as their rights.

It is known the most cases of teenage pregnancy are expressed in people with few money, in poverty situation and social exclusion, people already showing access lack to education and health, bringing out individuals with low or almost nule development opportunities to the world, those are shown since early times, frustration in life plans and unadequate transition to adult life, setting up and enlarging poverty and under-development of society.
Under these criteria, we have desertion and empty schools, low-remunerated jobs, and sometimes under less than human conditions, raising gender violence indexes, broken families, among others.

In the other hand, we have all the problems around teenage pregnancy.
Here we face increasing of morbility/mortality during birth and after-birth, that is expressed in obsthetric complications due to biological inmadurity and constitutionof female teenager.
Just to mention some, we have: hypertension, hemorrages and infections, and abortion, those many times are done at unhealthy places, so they unchain a series of events attempting health, unless they finish on death.

Here we also face directly to suicide, what is very hard to draw out.
We also have malnutrition not only in the mother because it is proven that female teenagers have more probability to have a child with low weight after birth.

Teenage Pregnancy Law
Unfortunately,there are two big legal obstacles to limit the access of teenagers to sexual and reproductive health services in Peru.
In one side, we have 28704 Rule, article 173, that punishes any sexual relation between and with teenagers, including freely agreed ones, negatively impacting on teenagers’ access to SRH services because there is fear to legal fine if teenagers attend to health services without parents or preceptors.

In the other side, we have General Rule of Health, article 4, that interpretate s teenager under 18 years old as dependant on agreement and companion of parents or preceptors to access to health services, including sexual and reproductive health ones.
Under this legal context, teenager can not access to adequate information by sexual and reproductive health specialists and contraceptive supplies , absence of pre-birth attention for already pregnant female teenager , in some cases the unadequate birth attention , among others. So all this just gets the situation worst  empowering mother and just born child’s morbility/mortality because, as we said before, there is fear to legal fine.

Peruvian Government, realising this legal crack, rules a Supreme Court’s linking precedent that states as inconstitutional  the punishment of  agreed sexual relations between and with teenagers from 14 to 18 years old, propitiating  so free access  and empowering of teenagers to sexual and reproductive health. However, its application needs time to get significant changes, as well it is needed continuing with advocacy to get a better access and service related to teenager’s sexual health.

Numbers of teenage pregnancy
According to Population and Social Development Demographic Survey (ENDES in Spanish) , in Peru, in 2012, 29% of female teenagers are sexually active, 13% of female teenagers from 15 to 19 years old are already mothers and/or are already pregnant of their first child. From total amount of teennage pregnancies, the proner and more vulnerable to pregnancy are the poorest, with few education and living at rural areas.
From total amount of pregnant female teenagers, only 32% wished to get pregnant.

All this let us to see an integral reality of teenager as a sexual subject, not as someones under a false moral veil who still pretend to conceive the teenager as as not-sexed subject without need of sexual education, because as they say, to speak the teenager about  sexuality means “getting up morbidity  and leading to sin.”

What must we do?
It must invest on teenager’s integral health, creating differentiated spaces for them, assigning proffessional specialists on sexual and reproductive health with a vision to postergate the beginning of teenagers’ sexual relations who want it so, offering needed tools to strengthen decisions taking and mutual respect.

To reach articulation of education and health, getting to hire sexual and reproductive specialists to give an adequate and held training in schools, assuring teenagers the differentiate access to their integral attention at different health centers.

To give free, on-time orientation and advisory to teenagers who already have an active sexual life, getting the right use of contraceptive method to avoid teenage pregnancy.
It must understand a female teenager is not mature because she is a mother but a female teenager with all limitations this life phase carries on, having to face the world for making a child to grow up.
Let’s make the change!

Thanks Jhon Gomez for his legal advisory. Marco Paulini is a proffessional obsthetrician. Send him your questions to his Twitter account, @MarcoPaulini.
Translated by Nelson Peñaherrera for FACTORTIERRA.NET.



Gender-based Violence (GBV)







To define what is gender-based violence, first we have to understand what the violence is.
In this point we say that the violence is the behavior or omision of it proposed to harm  or wound the other person  violating so the rights of the other individual. In other words, it is an intentional behavior .


What is Gender-based Violence?

World Health Organization (who) and Pan-American Health Organization (PAHO) define it as “all act of physical or verbal power, coertion  or threatening privation for the life, addressed to woman or girl,  that causes physical or psychological hazard , humiliation, or arbitrarian privation of freedom, and that enlarges female subordination as well as it produces in public or private life.”

Many times, GBV is inserted in daily life of women , generating effect of systematic victimization in female gender, and hat does not discriminate among girls, teenagers, young, adult and elder women, causing the violence goes unseen, originating a kind of ghost violence, adding to non-identification of itself.

Here is necessary to learn the difference between GBV and other types of interpersonal or social violence, recognizing GBV’s objective is women submission before dominion of who has power and so  the control. Generally, it is inflicted by lover and/or relative , and inside home. The woman is the target of submission, I mean.
Despite in violence without gender origin, the victim can be whoever, even a male, the agressor can be a strange r or ocassional friend, and space where it is made can be wherever.

Is GBV a human rights violation?

Because it is base don unequity to women in the practice and distribution of power in society, it is proven that GBV violates human rights, and it is almost linked to violence against under legal age people.

In a more panoramic view, we can appreciate that in domestic environment , when women’s human rights are violated, also her children’s human rights are violated, so their right to live and grow up  in violenc-free environments is nullified. This way, children turn victims and witnesses of gender terror and degradation, when living with an adult with a wrong feeling or conviction of his wife’ & family members (children)’ belonging or control .

Is sexual violence a type of GBV?

Yes, it is. And it makes evident because female body is perceived, conquered and dominated as territory of male belonging and dominion. This expresses in emotional, physical, economic empowerment, blackmail or threaten for penetration or any sexual contact to women, whoever girl, teenager or adult, including cultural practices like genital mutilation, forced marriages, virginity overvaloration, among others.

Many times, culture itself justifies and legates the feeling of female body and sexuality’s conquer to their men, teaching to women for accepting themselves as male property, masking a pathological relationship of dominion and dependance that is passed from generation to generation.

Special attention must be given to marriage duty, the bad marriage principle that forces the wife to satisfy her husband’s sexual desire just because she is his wife, ignorating her desire as a woman. As it is covered under marriage or convivence veil, vilence gets impune and vigent as high as sometimes it is undetectable by the same women who experience it, assuming it is part of the normal because of the fact they are women.

Let’s see a daily example:
The mother as the only responsible of house chores.
The father as the only responsible for family and with authority for taking decisions.
It is observed here that the violence is “justified and normal.”
The most common types of GBV are childhood’s sexual abuse, domestic violence and rape.

Is GBV a public health problem?
Yes, it is. As it has a negative impact on women’s integral health, GBV repercutes on health of society. That’s why watching has to be held because it is not an isolated trend but it has origing and a negative impact around the world.
In that sense, it is a conclusion that woman’s health has to be contemplated by public policies proned to gender equity, that guarantees welfare and justice for their members, throughout elimination of carrying factors to woman’s victimization and violence because of her gender.

We, the men speak up

Many times, we, the males show violence trending to solve conflicts. Then, a question jumps automatically up: is violence necessary to solve conflicts?
There are who unavoidabily connect conflict to violence and believe that preventing the violence is necessary to prevent the conflict.

But in human reasonability, we realize that independently of male or female gender, we have different interests, aspirations, goals and values as individuals, and conflict is hard to avoid while we interact.  But depend on ourselves to learn solving them without violence by the mutual agreement that satisfies both parties through consensus and reason.

Unfortunately many times, the violent act made by the man is considered as normal and it is justified by rebelion and non-recognizement of women. Here we have cotidaneus arguments those mask GBV: “She provocates me”, “I’m the boss at home”, “She doesn’t respect on me.”

As part of this vicious circle, the male kids growing under a violent environment follow building up their manhood based on superiority granted by the machoman thinking, and they will show out in the future  turning in agressors when exercising their supossed authority, it gets threatened or questioned by women.

Within the main fears of men who were growth and masculinized under a violent environment, we have the fear of no reaching the true men standards and being humiliated or ashamed as a feminine husband, going over their empowerment and having to submit the woman as their manhood proof.
In this context, men learn since they are kids, and continously their manhood is tested by society , having to show it even violating  women and the weakest and the rest.

What can I do as a man?

We have to begin analyzing ourselves frantically about who we are as men, less competitive before the female.
This is not going to be really easy because we have growth as machomen, so this process will not happen immediately. But let’s exercise the free choosing stopping violence at home, being perseverant in our decision if we propose to change for real and for family welfare.

Anyway, we have to minimize our violent acts. Let’s remember there is not big or small violence – all types are acts to be discarded. Have in mind that nothing justifies our violence, so we are the only responsible of our violent acts. Learn to self-satisfize our needs not expecting the women do them on behalf of us because ooa superiority sense. This is key to prevent many conflicts leading to violent facts.

Learn to self-detect the syntoms when we are just ready to explode for avoiding the trigger to violence. We have to learn the skill to realize that in those conditions we can not follow a discussion because we will not able to hear and what we think or feel wil be the only important, putting on risk everything to end as a violent act. So it is better to have a time-out and step outside. Of course, stepping outside will cos tus because we will feel we are weakand we are losing in a fight, but if we are decided to change, we have to decide between continuing to argue and probably end to a violent act, or stepping us outside to get calm and agree a consensus with the couple in other moment, satysfying both.

Time-out or stepping outside is a time to be used mainly to slow down and do activities those support this objective. A good choice is walking outdoors and alone for thinking clear. Never look for friends who support you as a machoman, or alcohol ‘to solve’ the problem.

For majority of men, the fact of negotiating and conciliating  is difficult and eben more when we have benn educated to impose us or to negotiate from a perspective of top power because we are male. This does not mean it is impossible but it demands a greater commitment to our couple and other family members.

Once we get steady, it is a grateful feeling we have got it and we will on our way to mutual respect and our recognizement as true men.
As we are able to unwear that shield we are wearing sice we were child as protection mechanism , and that implies to be unsensitive before the rest and ourselves,  we could compare what we get by affective links to family is superior to we lose by dominion , making the change sustainable.

As a closure, we can say we are going to be better men as much as we start  to recuperate our sensitive and loving capability that culture and ssociety have erased.
Let’s make the change!

(Marco Paulini is a Sullana,Peru-based obsthetrician. Send your questions to his Twitter account, @MarcoPaulini)
© 2014 asociación Civil Factor Tierra (@factortierra on Twitter)
© 2014, 2016 by Marco Paulini. All Rights Reserved.
Post-produced by Sheyla Benavente.

martes, 28 de junio de 2016

The “bride” goes white and… shiny?

Marco Paulini - Peru
 
The silence was broken by the bells ringing, while dizzy white birds flew around gracefully over who congregated for wishing them prosperity.
His impatience vanished when he saw her. A smile was drawn on his face looking at her 14-spring-old beautiness. His happiness could be seen, and how he proudly waited for her, like whoever waiting for recognizement for having a won  battle.
She went white, shiny, held in the arm by her father, who accompanied her to the shrine, while her pretty-well-dressedmother cried.
“It’s better so. Every woman reaches the time to begin a nest,” another women, all outfit straight for that moment, said her.
“Be proud. Not all of us could went out white-dressed like your daughter,” another one said.
“If he isn’t, somebody else will bring her out,” someone else said.
“She’s getting married as God command -  nobody could criticize her,” another one else whispered.
From the congregated there, an angel watched the scene and cried remembering all the happy lived moments next to her older little sister and, eyewitnessing all events ending into a wedding, could not stop asking: “will this happen anytime to me too?”
She was seen beauty walking to the shrine  while a girl guided her way with a little basket full of rose pieces. She, excited by the wedding song, felt overwhelmed by so many feelings. She tought inside “In the end, who doesn’t want having an assured future beside a rich man, on his forties also? He has got madurity what a boy of my age doesn’t.”
She encouraged, preferred just thinking if to bring Julieta, his companion since she was just 7 years old wwhen Aunt Matilde gift her, to her new home would be badly seen. Even when Julieta, her doll, was old, she was her only ssecret keeper.
Behind her veil, innocence and femenity of her years could be drawn. Her veil and her hair curl playfully was hidding the rouge after the slap she was infringed by her father the night before, when she confessed him she didn’t want to get married, while her inmacullate white dress simulated well she was two months of pregnancy.
An almost angelical choir sounded while her father deserved his babe to the sorry rapist.
Then, are you the bride or who waited for her? Continuing or stoping gender violence depends on you.